Healthcare Provider Details

I. General information

NPI: 1861020927
Provider Name (Legal Business Name): LAUREN ELIZABETH RUSSELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 N MAYS ST STE 430
ROUND ROCK TX
78664-2108
US

IV. Provider business mailing address

2423 WILLIAMS DR STE 107
GEORGETOWN TX
78628-3269
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-5722
  • Fax:
Mailing address:
  • Phone: 877-800-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV1604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: